AB0798 The presence of heel enthesitis during physical exploration in patients with radiographic axial spondyloarthritis is associated with poorer outcomes after 2 years of follow-up. Data from REGISPONSER-AS
Authors: C. López-Medina, M. Á. Puche Larrubia, M. L. Ladehesa Pineda, R. E. M. Granados, F. U. Pilar, E. Collantes Estevez
Journal: Annals of the Rheumatic Diseases (2022)

Background Enthesitis represents one of the most important peripheral musculoskeletal manifestation in patients with axial Spondyloarthritis (axSpA). The prevalence and the burden of the disease associated with this symptom have been widely studied in axSpA and Psoriatic Arthritis (PsA). However, studies evaluating specifically the heel enthesitis and its impact over time are scarce. Objectives A) to evaluate the prevalence of patients with heel enthesitis during physical exploration in patients with radiographic axSpA (r-axSpA); b) to evaluate the association of heel enthesitis with higher Patient Reported Outcomes (PROs); c) to assess the impact of the heel enthesitis on the outcome measures after two years of follow-up in these patients. Methods Observational and prospective study during 2 years of follow-up that included patients with r-axSpA from the REGISPONSER-AS study (Spanish Rheumatology Spondyloarthritis Registry). The patients were divided into two groups according to the presence on heel enthesitis on physical exploration during the study visit. The PROs evaluated were the Global VAS, BASDAI, ASDAS, BASFI and the mental and physical components from the SF12 questionnaire. Linear regression models were performed using the PROs as the dependent variable and the presence of heel enthesitis as the explanatory variable, adjusting for bDMARDs intake and age. The impact of the heel enthesitis on PROs over two years of follow-up was evaluated using mixed models for repeated measures adjusting for confounders. Finally, the achievement of ASDAS Low Disease Activity (ASDAS-LDA) and ASDAS Inactive Disease (ASDAS-ID) after 2 years of follow-up between the two groups were evaluated. Results 749 patients were included (mean age 48.4 years; 75.3% men). 46 (6.1%) patients suffered from heel enthesitis on the study visit. Patients with heel enthesitis showed an increase (β coefficient, 95%CI) in Global VAS (1.32, 0.52-2.12), BASDAI (1.49, 0.81-2.18), ASDAS (0.45, 0.12-0.77) and BASFI (9.54, 1.78-17.30) compared with patients without heel enthesitis after adjusting for confounders. The impact of the presence of enthesitis on the PROs after two years of follow-up is shown in Table 1. Patients with heel enthesitis showed higher scores during the two years of follow-up in Global VAS, BASDAI, ASDAS and BASFI. In addition, the percentage of patients who achieved ASDAS-LDA after 2 years of follow up was lower in patients with heel enthesitis (15.9% vs. 31.5%, p=0.030) in comparison with patients without enthesitis. No differences were found regarding ASDAS-ID. Table 1. Impact of the presence of heel enthesitis on PROs over two years of follow-up: mixed models for repeated measures. Current heel enthesitis N = 46 Mean (SD ) No current heel enthesitis N = 703 Mean (SD ) p-value p-value age and bDMARDs adjusted Global VAS 5.1 (2.8) 4.3 (2.6) 0.015 0.010 BASDAI 4.8 (2.7) 3.9 (2.7) &lt;0.001 &lt;0.001 ASDAS 2.9 (1.1) 2.6 (1.0) 0.007 0.005 BASFI 43.8 (29.7) 40.0 (27.4) 0.245 0.161 PC-SF12 33.3 (11.4) 35.3 (10.7) 0.128 0.110 MC-SF12 47.4 (14.2) 48.2 (12.2) 0.547 0.281 Conclusion In patients with r-axSpA, the presence of heel enthesitis on physical exploration was associated with poorer scores ​​on the outcome measures after two years of follow-up, in comparison with patients without heel enthesitis. The achievement of a low disease activity is less likely in patients with this manifestation. Disclosure of Interests None declared